NPI | 1407384209 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26485) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0134584) |
Enumeration Date | 2017-05-24 |
Last Update Date | 2023-05-30 |