NPI | 1689793473 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 20870) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 32747) |
Enumeration Date | 2007-03-29 |
Last Update Date | 2007-07-08 |