| NPI | 1720797343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 033876) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2025-01-01 |