NPI | 1538601547 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA PT027224) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT31921) |
Enumeration Date | 2016-11-08 |
Last Update Date | 2019-03-26 |