NPI | 1528490695 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT25696) |
Additional Taxonomies | 174400000X Specialist (Licence: FL PTS25696) |
Enumeration Date | 2013-07-31 |
Last Update Date | 2022-05-03 |