| NPI | 1437997046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033684) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16861-24) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-07-17 |