| NPI | 1740063114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 33182) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 33182) |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2024-01-08 |