| NPI | 1619050614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 006976) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 28940) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2021-03-13 |