| NPI | 1679127542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 31895) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2019027904) |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2022-07-25 |