NPI | 1598874265 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36858) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2140) |
225100000X Physical Therapist (Licence: MA 19894) | |
Enumeration Date | 2006-08-29 |
Last Update Date | 2022-06-19 |