NPI | 1598265290 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 293927) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CA 293927) |
2251X0800X Physical Therapist, Orthopedic (Licence: CA 293927) | |
Enumeration Date | 2018-02-19 |
Last Update Date | 2022-03-24 |