NPI | 1114574670 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42558) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03215) |
225100000X Physical Therapist (Licence: SC 10960) | |
Enumeration Date | 2019-08-20 |
Last Update Date | 2025-01-22 |