NPI | 1154324077 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 8042) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 001132) |
Enumeration Date | 2005-05-24 |
Last Update Date | 2020-08-03 |