NPI | 1639608623 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-013053) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 13053) |
Enumeration Date | 2017-06-05 |
Last Update Date | 2023-11-08 |