NPI | 1215155940 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013273) |
Additional Taxonomies | 171W00000X Contractor (Licence: FL LPTA19978) |
Enumeration Date | 2007-04-20 |
Last Update Date | 2018-06-19 |