| NPI | 1326098427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-002529) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 2529) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-03-26 |