| NPI | 1821226044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 8534) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8534) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: AZ 8534) | |
| 2251S0007X Physical Therapist, Sports (Licence: AZ 8534) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2022-02-08 |