| NPI | 1093260473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32120) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26114) |
| 225100000X Physical Therapist (Licence: MA 24146) | |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2022-04-05 |