| NPI | 1952601742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9047) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: AZ 4607) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2016-10-12 |