| NPI | 1679264147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32964) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 306122) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2024-07-15 |