NPI | 1235699588 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 21456) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MA 89) |
Enumeration Date | 2019-03-22 |
Last Update Date | 2021-06-28 |