| NPI | 1487306759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32154) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2022001754) |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2025-02-28 |