| NPI | 1639919640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP051011T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 11820) |
| Enumeration Date | 2024-05-28 |
| Last Update Date | 2025-11-20 |