NPI | 1568811693 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 30287) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61745) |
225100000X Physical Therapist (Licence: AZ 30287) | |
Enumeration Date | 2016-06-09 |
Last Update Date | 2020-05-07 |