| NPI | 1801886056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 0803) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 803) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2017-10-10 |