| NPI | 1730414905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 10050) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031791) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 10050) | |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2021-10-11 |