NPI | 1982093134 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 43538) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 038580-1) |
Enumeration Date | 2015-01-12 |
Last Update Date | 2018-11-27 |