| NPI | 1881165090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ IP-18-08) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-30626) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2024-11-15 |