NPI | 1255846044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211394) |
Additional Taxonomies | 225100000X Physical Therapist |
Enumeration Date | 2017-12-03 |
Last Update Date | 2021-06-21 |