NPI | 1972935674 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 22785) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207097) |
Enumeration Date | 2013-08-05 |
Last Update Date | 2018-12-20 |