| NPI | 1528312154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-010749) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2770) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2024-07-30 |