| NPI | 1285790592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT1104) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: AR PT1104) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2025-04-01 |