| NPI | 1649944059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP030320T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02026700) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2024-09-22 |