NPI | 1790415818 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2022031575) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-07045) |
Enumeration Date | 2022-06-13 |
Last Update Date | 2022-08-23 |