| NPI | 1063965580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| 2251X0800X Physical Therapist, Orthopedic | |
| 225100000X Physical Therapist (Licence: AZ 12226) | |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2024-05-31 |