| NPI | 1043797210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 13490) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT293328) |
| 225100000X Physical Therapist (Licence: NV 3631) | |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2021-11-09 |