| NPI | 1922697523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ LPT-32271) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 11802753-2401) |
| Enumeration Date | 2021-01-18 |
| Last Update Date | 2022-06-28 |