| NPI | 1629524509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27307) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 12511) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2018-12-20 |