| NPI | 1871577494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 8768) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 1466) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2018-09-05 |