NPI | 1700402559 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 4802953) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5502005126) |
Enumeration Date | 2020-06-17 |
Last Update Date | 2020-06-28 |