NPI | 1255589016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: PA PT018791) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT018791) |
225100000X Physical Therapist (Licence: PA PT018791) | |
Enumeration Date | 2008-09-05 |
Last Update Date | 2022-10-18 |