| NPI | 1245846690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ LPT-31414) |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2024-11-01 |