NPI | 1538631049 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1302440) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60839855) |
225100000X Physical Therapist (Licence: OR 62636) | |
Enumeration Date | 2018-12-21 |
Last Update Date | 2020-07-19 |