| NPI | 1043045578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 033953) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16721-24) |
| 225100000X Physical Therapist (Licence: VA CP033302T) | |
| Enumeration Date | 2024-09-04 |
| Last Update Date | 2024-12-26 |