NPI | 1295896553 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: VA 2305006240) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 291422) |
Enumeration Date | 2006-12-12 |
Last Update Date | 2019-03-27 |