NPI | 1114791092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41063) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-034056) |
225100000X Physical Therapist (Licence: VA 2305216170) | |
225100000X Physical Therapist (Licence: CO PTL.0019776) | |
Enumeration Date | 2023-11-10 |
Last Update Date | 2025-09-27 |