NPI | 1902259401 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 095960) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013959) |
225100000X Physical Therapist (Licence: MO 2016020602) | |
Enumeration Date | 2016-07-20 |
Last Update Date | 2019-09-13 |