| NPI | 1972953990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AR PT4138) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26630) |
| 225100000X Physical Therapist (Licence: AR PT4138) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2023-06-14 |