NPI | 1770158750 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 304092) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501019875) |
Enumeration Date | 2021-05-23 |
Last Update Date | 2024-01-30 |