| NPI | 1649584004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9010) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: AZ LPT-00009010) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AZ LPT-00009010) | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2019-11-24 |