NPI | 1184784571 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-6164) |
Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA 11095) |
Enumeration Date | 2006-12-08 |
Last Update Date | 2024-04-03 |