| NPI | 1477243079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT033634) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29574) |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2024-06-20 |