NPI | 1750848214 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-27322) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305212609) |
Enumeration Date | 2019-02-20 |
Last Update Date | 2025-04-09 |