NPI | 1215054663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: HI PT-1939) |
Additional Taxonomies | 225700000X Massage Therapist (Licence: HI MAT-9599) |
Enumeration Date | 2007-03-23 |
Last Update Date | 2023-12-23 |