NPI | 1508426164 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212908) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: VA 2305212908) |
Enumeration Date | 2019-06-17 |
Last Update Date | 2020-09-17 |