| NPI | 1154006526 |
|---|---|
| Former Name | AVERY NIKOLAS PEREZ |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OT023641) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OT023641) |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2025-06-26 |