| NPI | 1639859275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033536) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P22805) |
| 225100000X Physical Therapist (Licence: MN 13043) | |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2024-04-19 |