| NPI | 1205400801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32004) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 12177812-2401) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2023-11-22 |