NPI | 1952060220 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 106224) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA 091762) |
Enumeration Date | 2021-12-14 |
Last Update Date | 2021-12-14 |