| NPI | 1023445129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-31177) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-1560) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2020-03-13 |