NPI | 1275956609 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35990) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT21817) |
225100000X Physical Therapist (Licence: NY 62 026558) | |
Enumeration Date | 2014-01-21 |
Last Update Date | 2022-02-11 |