NPI | 1053063461 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305209300) |
Enumeration Date | 2022-01-26 |
Last Update Date | 2024-09-13 |