NPI | 1295293652 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT-34078) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT-34078) |
2251P0200X Physical Therapist, Pediatrics (Licence: ID PT6215) | |
Enumeration Date | 2019-03-05 |
Last Update Date | 2021-06-28 |