NPI | 1598869513 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 9446) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT00009997) |
2251X0800X Physical Therapist, Orthopedic (Licence: KS 11-03512) | |
2251X0800X Physical Therapist, Orthopedic (Licence: MO 2005029540) | |
Enumeration Date | 2006-09-11 |
Last Update Date | 2015-04-07 |