NPI | 1699204800 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41169) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26510) |
Enumeration Date | 2017-06-09 |
Last Update Date | 2024-01-12 |