| NPI | 1629594015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 033951) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23224) |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2024-12-26 |