| NPI | 1508488107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11690251-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-6993) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2024-04-04 |