| NPI | 1386846327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: AZ #MT-15040) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 7682A) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2014-02-18 |