NPI | 1982609541 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305202501) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 19525) |
Enumeration Date | 2005-06-20 |
Last Update Date | 2023-12-21 |