NPI | 1104895200 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210224) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017332) |
225100000X Physical Therapist (Licence: NE 2744) | |
Enumeration Date | 2006-03-14 |
Last Update Date | 2022-04-12 |