| NPI | 1679056444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ LPT-30300) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2025-02-12 |