| NPI | 1255870812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-30453) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1281976) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WA 60782214) | |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2023-11-08 |