NPI | 1922550763 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4707) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0013422) |
225100000X Physical Therapist (Licence: MI 5501017461) | |
Enumeration Date | 2016-10-27 |
Last Update Date | 2016-10-27 |