| NPI | 1942371216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 6673) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: AZ 6673) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2013-02-18 |