| NPI | 1477281095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22353) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-31535) |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2024-02-08 |