| NPI | 1669720363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11366) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12085-24) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2015-03-10 |