NPI | 1982220315 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 15133-24) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 11807) |
225100000X Physical Therapist (Licence: MN 11807) | |
Enumeration Date | 2020-06-22 |
Last Update Date | 2021-03-02 |