NPI | 1578556932 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18400) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501009503) |
Enumeration Date | 2005-08-31 |
Last Update Date | 2019-08-22 |