| NPI | 1225486608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 8704023-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-4423) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2022-06-02 |