| NPI | 1619587755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 31456) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2023-08-16 |