NPI | 1710258561 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35244) |
Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: CA 35244) |
Enumeration Date | 2012-01-24 |
Last Update Date | 2012-01-24 |