| NPI | 1598451726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-32231) |
| 225100000X Physical Therapist (Licence: MD CP021345T) | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2024-04-12 |