NPI | 1639263718 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 64923) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 00010235) |
Enumeration Date | 2006-10-03 |
Last Update Date | 2023-07-31 |