NPI | 1811373996 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60898830) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT024484) |
Enumeration Date | 2015-07-30 |
Last Update Date | 2021-06-23 |