NPI | 1366950347 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist |
Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NV 4113) |
2251N0400X Physical Therapist, Neurology (Licence: NV 4113) | |
2251S0007X Physical Therapist, Sports (Licence: NV 4113) | |
2251X0800X Physical Therapist, Orthopedic (Licence: NV 4113) | |
Enumeration Date | 2018-01-12 |
Last Update Date | 2020-01-16 |