| NPI | 1700232220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-30034) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 072900) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2022-05-10 |