NPI | 1104307610 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25740) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP033499T) |
225100000X Physical Therapist (Licence: MA PTL25782) | |
Enumeration Date | 2018-08-22 |
Last Update Date | 2024-10-02 |