NPI | 1700544194 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215613) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 048132) |
Enumeration Date | 2021-12-02 |
Last Update Date | 2024-10-08 |