| NPI | 1780929299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-31542) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT25826) |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2021-07-10 |