NPI | 1902451735 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 17606) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1322378) |
Enumeration Date | 2019-08-08 |
Last Update Date | 2021-06-09 |