NPI | 1760158638 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 25633) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MA 25633) |
Enumeration Date | 2021-08-19 |
Last Update Date | 2021-08-19 |