| NPI | 1376074187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 7702617-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-4631) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2017-03-23 |