NPI | 1740874601 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0018159) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36644) |
Enumeration Date | 2021-02-22 |
Last Update Date | 2022-03-02 |