NPI | 1215200415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32878) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA22671) |
Enumeration Date | 2012-02-17 |
Last Update Date | 2022-07-21 |