NPI | 1972135010 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-6475) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-6475) |
2251S0007X Physical Therapist, Sports (Licence: ID PT-6475) | |
Enumeration Date | 2020-02-06 |
Last Update Date | 2023-12-22 |