NPI | 1790119436 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0012253) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-1625) |
Enumeration Date | 2013-08-29 |
Last Update Date | 2020-03-18 |