NPI | 1063873651 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292087) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034084) |
225100000X Physical Therapist (Licence: WA PT60408466) | |
Enumeration Date | 2016-03-10 |
Last Update Date | 2018-12-31 |