NPI | 1073907093 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT018407) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01580400) |
Enumeration Date | 2015-03-27 |
Last Update Date | 2020-02-13 |