NPI | 1548503071 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 41034) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034087) |
225100000X Physical Therapist (Licence: HI PT-4164) | |
Enumeration Date | 2013-04-03 |
Last Update Date | 2016-03-11 |