NPI | 1104219914 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT002638) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305202488) |
Enumeration Date | 2015-03-18 |
Last Update Date | 2021-01-19 |