| NPI | 1770830903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 12000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 34735) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2024-06-13 |