NPI | 1043603814 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1356635) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 26939) |
235Z00000X Speech-Language Pathologist, (Licence: CA 19350) | |
235Z00000X Speech-Language Pathologist, (Licence: TX 119077) | |
Enumeration Date | 2015-03-18 |
Last Update Date | 2024-06-17 |