NPI | 1750631834 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11017) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT39963) |
225100000X Physical Therapist (Licence: WA PT60436636) | |
Enumeration Date | 2012-09-14 |
Last Update Date | 2021-10-05 |