| NPI | 1336174481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-006289) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 29436) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-10-12 |