| NPI | 1811358344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 12891) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039932) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2017-03-30 |