NPI | 1972075430 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36679) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 011700-1) |
Enumeration Date | 2018-12-21 |
Last Update Date | 2022-01-21 |