| NPI | 1407952435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 5440) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: AZ 5440) |
| 2251H1300X Physical Therapist, Human Factors (Licence: AZ 5440) | |
| 2251N0400X Physical Therapist, Neurology (Licence: AZ 5440) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 5440) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2021-08-02 |