| NPI | 1497220073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63044) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-30115) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2018-11-06 |