| NPI | 1659064640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034044) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: TX 1399766) | |
| Enumeration Date | 2023-05-26 |
| Last Update Date | 2025-02-12 |