NPI | 1083152292 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60861842) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1287583) |
Enumeration Date | 2017-02-08 |
Last Update Date | 2019-03-01 |