NPI | 1013600907 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT31698) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1353113) |
225100000X Physical Therapist (Licence: GA PT012576) | |
Enumeration Date | 2023-05-29 |
Last Update Date | 2023-05-29 |