| NPI | 1194330613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-31525) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P19808) |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2021-04-05 |