NPI | 1356912802 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 64509) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MT PTP-PT-LIC-21667) |
Enumeration Date | 2021-07-06 |
Last Update Date | 2022-08-25 |