NPI | 1962965137 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-011420) |
Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: AZ LPT-011420) |
Enumeration Date | 2019-04-12 |
Last Update Date | 2025-08-27 |