| NPI | 1689349136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ LPT-33241) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT029743) |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2025-03-28 |