NPI | 1548785579 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4455) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO PTL.0015120) |
Enumeration Date | 2017-08-10 |
Last Update Date | 2019-01-11 |