NPI | 1194360180 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211904) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
Enumeration Date | 2019-11-13 |
Last Update Date | 2021-03-22 |