NPI | 1518432855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 295271) |
Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA PT295271) |
Enumeration Date | 2018-10-12 |
Last Update Date | 2024-05-15 |