NPI | 1700281771 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 20718) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21194) |
Enumeration Date | 2014-11-03 |
Last Update Date | 2025-07-10 |