| NPI | 1619522513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32098) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 296970) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2021-12-04 |