NPI | 1184023236 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1244890) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.025922) |
225100000X Physical Therapist (Licence: PA PT029569) | |
225100000X Physical Therapist (Licence: NY 048345) | |
Enumeration Date | 2014-08-14 |
Last Update Date | 2022-03-15 |