| NPI | 1275365140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034116) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2025-11-07 |