| NPI | 1710495544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 6119) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN129482) |
| Enumeration Date | 2018-01-15 |
| Last Update Date | 2018-01-15 |