| NPI | 1629734637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32999) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047726) |
| Enumeration Date | 2021-11-14 |
| Last Update Date | 2023-10-03 |