| NPI | 1417205188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26417) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 9877) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2017-04-11 |