| NPI | 1316722283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT33218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CPO36969T) |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2024-11-18 |