NPI | 1114306941 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-31604) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013279) |
Enumeration Date | 2015-05-26 |
Last Update Date | 2021-03-04 |