| NPI | 1962404293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-001135) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 1135) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2021-02-04 |