| NPI | 1336181569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 6398) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: AZ 6398) |
| 2251H1200X Physical Therapist, Hand (Licence: AZ 6398) | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: AZ 6398) | |
| 2251S0007X Physical Therapist, Sports (Licence: AZ 6398) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 6398) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2007-10-16 |