| NPI | 1861255747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033620) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT032003) |
| Enumeration Date | 2024-02-02 |
| Last Update Date | 2024-08-28 |