| NPI | 1376008094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 13327655-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-5982) |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2023-04-26 |