NPI | 1154724979 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211263) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DC pt871727) |
Enumeration Date | 2014-10-07 |
Last Update Date | 2018-05-08 |