| NPI | 1497993422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 4224) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 1171) |
| Enumeration Date | 2009-01-29 |
| Last Update Date | 2009-01-29 |