NPI | 1205506912 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21412) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28688) |
225100000X Physical Therapist (Licence: SC 10839) | |
Enumeration Date | 2021-09-14 |
Last Update Date | 2024-11-13 |