| NPI | 1174299473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-31984) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-7312) |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2025-02-12 |