| NPI | 1639953615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP039082T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT016714) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2024-12-30 |