| NPI | 1568761237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32183) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 9226A) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2022-01-25 |