NPI | 1619421591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63239) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025539) |
Enumeration Date | 2016-08-09 |
Last Update Date | 2019-09-19 |