NPI | 1023562618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018969) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 10433) |
Enumeration Date | 2016-08-11 |
Last Update Date | 2023-08-14 |