| NPI | 1497841167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11359) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 9914) |
| 225100000X Physical Therapist (Licence: AZ 7409) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-12-14 |