| NPI | 1861025017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 31148) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1327967) |
| Enumeration Date | 2020-02-17 |
| Last Update Date | 2020-02-17 |