NPI | 1396392650 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213112) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 42589) |
Enumeration Date | 2019-08-21 |
Last Update Date | 2025-01-15 |