NPI | 1023496015 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4405) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036734) |
225100000X Physical Therapist (Licence: OR 61091) | |
225100000X Physical Therapist (Licence: FL PT31869) | |
225100000X Physical Therapist (Licence: TX 1241843) | |
Enumeration Date | 2015-05-11 |
Last Update Date | 2018-05-22 |