| NPI | 1700447612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11936802-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-30238) |
| Enumeration Date | 2019-06-23 |
| Last Update Date | 2022-09-28 |