NPI | 1104296581 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR 62235) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 43134) |
Enumeration Date | 2015-09-29 |
Last Update Date | 2024-03-27 |