NPI | 1114467131 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 113044) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62149) |
225100000X Physical Therapist (Licence: MN 11771) | |
Enumeration Date | 2017-02-24 |
Last Update Date | 2022-08-17 |