NPI | 1972902617 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11037) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
2251X0800X Physical Therapist, Orthopedic | |
Enumeration Date | 2014-08-19 |
Last Update Date | 2015-09-11 |