| NPI | 1356190003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP042959T) |
| 225100000X Physical Therapist (Licence: NE 4620) | |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2025-03-19 |