NPI | 1639414196 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP025743T) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9485) |
Enumeration Date | 2012-12-10 |
Last Update Date | 2024-10-31 |