| NPI | 1629315973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 08970R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10114) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2015-11-11 |