NPI | 1134715485 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215905) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046802) |
225100000X Physical Therapist (Licence: PA PT031252) | |
Enumeration Date | 2020-12-21 |
Last Update Date | 2025-08-08 |