NPI | 1194394528 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020536) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2021033700) |
225100000X Physical Therapist (Licence: TN 16293) | |
Enumeration Date | 2021-06-21 |
Last Update Date | 2025-05-26 |