NPI | 1154713501 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15435) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013649) |
225100000X Physical Therapist (Licence: MT PTP-PT-LIC-9394) | |
225100000X Physical Therapist (Licence: AZ LIC-30420) | |
Enumeration Date | 2015-02-23 |
Last Update Date | 2019-02-20 |