NPI | 1053059642 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP026249T) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215020) |
Enumeration Date | 2022-05-24 |
Last Update Date | 2023-12-14 |