| NPI | 1699294504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 30233) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23259) |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2018-09-05 |