| NPI | 1952299034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034190) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501303745) |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2025-09-03 |