| NPI | 1427729300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 31876) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: AZ LPT-31876) |
| Enumeration Date | 2021-09-21 |
| Last Update Date | 2022-07-25 |