| NPI | 1275335549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034263) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ IP-25-02) |
| 225100000X Physical Therapist (Licence: AZ IP-25-02) | |
| Enumeration Date | 2025-03-26 |
| Last Update Date | 2025-08-27 |