| NPI | 1972699643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-008850) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 32379) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2022-05-10 |