NPI | 1487214540 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34664) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT34664) |
2251X0800X Physical Therapist, Orthopedic (Licence: FL PT34664) | |
Enumeration Date | 2019-06-19 |
Last Update Date | 2025-01-06 |