| NPI | 1457921231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 32304) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 107049) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2022-04-08 |