NPI | 1194925115 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4093) |
Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: OK 4093) |
2251S0007X Physical Therapist, Sports (Licence: OK 4093) | |
2251X0800X Physical Therapist, Orthopedic (Licence: OK 4093) | |
Enumeration Date | 2007-07-18 |
Last Update Date | 2024-04-06 |