| NPI | 1053914713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019027819) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP025024T) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2026-08-27 |