| NPI | 1801452131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11361126-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-6085) |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2025-11-17 |