| NPI | 1902155344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 10665) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 3537) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2018-03-17 |