| NPI | 1942859343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033461) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305211907) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2024-08-06 |