| NPI | 1023661915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ PT015305) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2019021009) |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2023-08-29 |