| NPI | 1821767880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: AZ 31980) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 31980) | |
| Enumeration Date | 2021-09-12 |
| Last Update Date | 2024-08-31 |