| NPI | 1457517112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9743PT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019425) |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2018-05-18 |