| NPI | 1801310149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-33133) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 087857) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2026-01-14 |