| NPI | 1184929168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 10358145-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-3831) |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2020-09-04 |