NPI | 1952736720 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016017) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60326237) |
225100000X Physical Therapist (Licence: ME PT4044) | |
225100000X Physical Therapist (Licence: WI 12192-24) | |
Enumeration Date | 2013-09-11 |
Last Update Date | 2021-07-07 |