NPI | 1134528409 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: AZ 31001) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9677) |
Enumeration Date | 2014-08-22 |
Last Update Date | 2019-12-18 |