| NPI | 1033773163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-30557) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24576) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2020-05-19 |