NPI | 1639442676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1266830) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MI B152847622012) |
Enumeration Date | 2012-02-22 |
Last Update Date | 2020-10-15 |