NPI | 1699731547 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: OR 3962) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 3962) |
Enumeration Date | 2006-04-20 |
Last Update Date | 2020-11-18 |