NPI | 1255999868 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24577) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27470) |
Enumeration Date | 2019-05-30 |
Last Update Date | 2020-01-02 |