| NPI | 1770130882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-30973) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2019030042) |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2020-03-02 |