NPI | 1104593359 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7224) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP049062T) |
Enumeration Date | 2021-08-25 |
Last Update Date | 2025-09-05 |