| NPI | 1801524038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033584) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215405) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2024-05-20 |