NPI | 1659519015 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2004028835) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.012079) |
Enumeration Date | 2009-01-23 |
Last Update Date | 2009-07-22 |