| NPI | 1568811693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: AZ 30287) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61745) |
| 225100000X Physical Therapist (Licence: AZ 30287) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2020-05-07 |