| NPI | 1508837519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 12570) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 02984) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2016-09-28 |