NPI | 1598380214 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19521) |
Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: NC P19521) |
Enumeration Date | 2020-06-09 |
Last Update Date | 2020-07-14 |