NPI | 1588912497 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211777) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27513) |
Enumeration Date | 2012-08-27 |
Last Update Date | 2020-11-24 |