NPI | 1144515743 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 17169) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 06545) |
Enumeration Date | 2011-06-13 |
Last Update Date | 2019-08-14 |