NPI | 1184285991 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0013705) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT296573) |
Enumeration Date | 2019-06-23 |
Last Update Date | 2019-12-07 |