| NPI | 1437531944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034401) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 5215) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2025-09-26 |