NPI | 1104510106 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1379859) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
Enumeration Date | 2023-06-05 |
Last Update Date | 2025-08-01 |