NPI | 1912144676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: MA 4830) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MA 4830) |
Enumeration Date | 2009-01-15 |
Last Update Date | 2015-09-25 |