| NPI | 1073097002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4341) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-30243) |
| Enumeration Date | 2018-09-15 |
| Last Update Date | 2021-11-01 |