NPI | 1063087575 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1345298) |
Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: TX 1345298) |
Enumeration Date | 2021-05-26 |
Last Update Date | 2023-06-19 |