NPI | 1639603509 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60860658) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 077348) |
Enumeration Date | 2017-04-17 |
Last Update Date | 2019-09-17 |