| NPI | 1831476407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9539) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 005153) |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2017-02-28 |