NPI | 1639624075 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 12397) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
2251X0800X Physical Therapist, Orthopedic | |
Enumeration Date | 2016-08-15 |
Last Update Date | 2016-08-15 |