| NPI | 1326476490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 11625) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24075) |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2015-09-17 |