| NPI | 1710456348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 24541) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-6002) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2023-08-22 |