| NPI | 1366750101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-9088) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 9088) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2024-12-13 |