| NPI | 1750864039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-31871) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 297382) |
| 225100000X Physical Therapist (Licence: KS 11-06170) | |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2022-06-01 |