| NPI | 1124752936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP014320T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 0000012394) |
| Enumeration Date | 2022-07-16 |
| Last Update Date | 2023-08-07 |