| NPI | 1639637614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 30117) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251E1200X Physical Therapist, Ergonomics (Licence: AZ 30117) | |
| 2251N0400X Physical Therapist, Neurology (Licence: AZ 30117) | |
| 2251S0007X Physical Therapist, Sports (Licence: AZ 30117) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 30117) | |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2021-06-25 |