| NPI | 1437456969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 10709) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033449-1) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2014-01-17 |