NPI | 1083064638 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2016019572) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05320) |
Enumeration Date | 2016-06-14 |
Last Update Date | 2016-06-14 |