| NPI | 1619611076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-31500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4395) |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2022-05-02 |