NPI | 1831186691 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: LA 00457) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 00457) |
Enumeration Date | 2005-10-05 |
Last Update Date | 2008-06-16 |