NPI | 1609916022 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: LA 00986) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 00986) |
Enumeration Date | 2007-02-07 |
Last Update Date | 2008-04-17 |