| NPI | 1407833684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-001391) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ AZ1391) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2021-06-10 |