NPI | 1952349482 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 07456) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: LA a3556) |
Enumeration Date | 2006-06-04 |
Last Update Date | 2021-01-28 |