| NPI | 1750123998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033854) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 4655) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2024-10-16 |