| NPI | 1063155810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP042940T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-24484) |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2025-04-07 |