| NPI | 1700308681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 10396276-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-5130) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2018-03-17 |