| NPI | 1396476602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32380) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 32380) |
| Enumeration Date | 2022-06-19 |
| Last Update Date | 2022-07-07 |