NPI | 1023091584 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1026052) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1026052) |
Enumeration Date | 2005-11-29 |
Last Update Date | 2023-12-15 |