| NPI | 1396061537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 6499) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 168) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2019-10-30 |