NPI | 1871210757 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MT 24621) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 18609) |
Enumeration Date | 2022-10-21 |
Last Update Date | 2022-12-12 |