NPI | 1184060899 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT21524) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 21524) |
Enumeration Date | 2013-05-21 |
Last Update Date | 2022-06-09 |