NPI | 1881355097 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28717) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD 28717) |
Enumeration Date | 2022-01-10 |
Last Update Date | 2022-01-10 |