| NPI | 1548006414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033632) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ LPT-033632) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2024-07-18 |