| NPI | 1609442250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: AR PT3908) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: AR PT3908) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2021-06-27 |