| NPI | 1467831073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: AZ 11525) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: AZ 11525) |
| 2251N0400X Physical Therapist Neurology (Licence: AZ 11525) | |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2015-05-28 |