| NPI | 1457875155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-013032) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 13032) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2023-05-16 |