| NPI | 1952982290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 31554) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1308518) |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2024-08-05 |