NPI | 1942676176 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8572) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT 003526) |
Enumeration Date | 2015-08-11 |
Last Update Date | 2022-07-21 |