| NPI | 1477281863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 033933) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 049084) |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2024-12-11 |