| NPI | 1104524578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP033305T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1374030) |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2024-09-25 |