| NPI | 1992544027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP034814T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT017080) |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-10-21 |