NPI | 1164660510 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23107) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029799) |
225100000X Physical Therapist (Licence: IA 004138) | |
225100000X Physical Therapist (Licence: TX 1184418) | |
Enumeration Date | 2009-01-22 |
Last Update Date | 2016-09-02 |