| NPI | 1528382744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 10352PT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT23805) |
| Enumeration Date | 2010-03-17 |
| Last Update Date | 2013-07-09 |