NPI | 1629098629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-1415) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
Enumeration Date | 2006-07-20 |
Last Update Date | 2018-10-24 |