NPI | 1629179825 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: VA 2305207237) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT008789) |
Enumeration Date | 2006-09-26 |
Last Update Date | 2012-05-07 |