| NPI | 1821634122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216408) |
| Additional Taxonomies | 226300000X Kinesiotherapist (Licence: MS 1945) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2024-05-20 |