| NPI | 1184292229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT32008) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 15425-24) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2021-09-23 |