NPI | 1912211848 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305206406) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305206406) |
Enumeration Date | 2010-08-03 |
Last Update Date | 2020-09-16 |