NPI | 1407101520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60977962) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004986) |
225100000X Physical Therapist (Licence: NE 3100) | |
Enumeration Date | 2012-07-15 |
Last Update Date | 2019-07-16 |