| NPI | 1295556371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21983) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-033895) |
| Enumeration Date | 2024-10-21 |
| Last Update Date | 2025-05-09 |