| NPI | 1578570081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 4229) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ C001071) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2014-10-24 |