NPI | 1023762739 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1248982) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1248982) |
Enumeration Date | 2022-02-10 |
Last Update Date | 2025-08-14 |