NPI | 1740664200 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 09080) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 09080) |
Enumeration Date | 2015-07-15 |
Last Update Date | 2015-08-04 |