| NPI | 1972056935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 12672) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 076353) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2016-11-15 |