NPI | 1194098517 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PT60112) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2012004495) |
Enumeration Date | 2012-02-15 |
Last Update Date | 2019-04-25 |