NPI | 1285268649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: DC PT872610) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213430) |
Enumeration Date | 2020-02-25 |
Last Update Date | 2024-03-04 |