NPI | 1790356855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015723) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 12306) |
Enumeration Date | 2021-07-08 |
Last Update Date | 2023-10-04 |