NPI | 1770126153 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 095446) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA 095446) |
Enumeration Date | 2019-10-18 |
Last Update Date | 2023-09-22 |