| NPI | 1952730491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP049850T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208116) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2025-10-27 |