NPI | 1184005423 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209481) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305209481) |
Enumeration Date | 2015-06-12 |
Last Update Date | 2019-03-21 |