| NPI | 1639484322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 8985) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ MT12341) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2013-03-12 |