| NPI | 1689403057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033773) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2024-08-26 |