| NPI | 1285151423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2021009036) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 13306PT) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2023-11-28 |