| NPI | 1518633031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12693) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-31973) |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2025-03-19 |