NPI | 1053890772 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 300139) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040321) |
Enumeration Date | 2018-08-13 |
Last Update Date | 2022-06-10 |