| NPI | 1043677610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 10658719-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3278) |
| 225100000X Physical Therapist (Licence: ID PT-4299) | |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2025-07-18 |