| NPI | 1467197285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 33062) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2023-07-05 |