| NPI | 1376248740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033894) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 26653) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2024-11-19 |