NPI | 1396106985 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-20168) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-4418) |
Enumeration Date | 2016-03-10 |
Last Update Date | 2021-03-11 |