| NPI | 1104515725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-005221) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206141) |
| 225100000X Physical Therapist (Licence: TN CP025049T) | |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2024-07-22 |