NPI | 1306115621 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 30815) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209874) |
225100000X Physical Therapist (Licence: NY 031785) | |
2251X0800X Physical Therapist, Orthopedic (Licence: FL PT30815) | |
Enumeration Date | 2011-12-15 |
Last Update Date | 2021-12-23 |