| NPI | 1538632351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 31878) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-4719) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 31878) | |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2023-01-26 |