| NPI | 1679219091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 32387) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2022-08-31 |