NPI | 1265503684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 008015) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017214) |
225100000X Physical Therapist (Licence: DE #J1-0001867) | |
Enumeration Date | 2006-11-10 |
Last Update Date | 2007-11-01 |