NPI | 1740521350 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7057) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 7057) |
Enumeration Date | 2013-03-06 |
Last Update Date | 2018-03-17 |