| NPI | 1659443703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 1376) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 1376) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2019-01-18 |