NPI | 1770168395 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214192) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029327) |
Enumeration Date | 2021-03-15 |
Last Update Date | 2021-11-20 |