NPI | 1104819812 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210751) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 017353-1) |
Enumeration Date | 2005-08-27 |
Last Update Date | 2018-04-16 |