NPI | 1174165476 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 297904) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60961686) |
Enumeration Date | 2019-10-08 |
Last Update Date | 2021-09-15 |