NPI | 1609120336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT023173) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6755) |
225100000X Physical Therapist (Licence: FL 27839) | |
Enumeration Date | 2012-11-02 |
Last Update Date | 2014-03-10 |