| NPI | 1467852053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-013600) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ LPT-013600) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2019-02-15 |