NPI | 1902455678 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 10455) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: LA 10455) |
2251X0800X Physical Therapist, Orthopedic (Licence: LA 10455) | |
Enumeration Date | 2019-09-05 |
Last Update Date | 2022-10-10 |