NPI | 1184971251 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT30530) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207562) |
Enumeration Date | 2012-08-08 |
Last Update Date | 2018-03-22 |