NPI | 1225698210 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT5415) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT5503) |
225100000X Physical Therapist (Licence: TX 1324750) | |
Enumeration Date | 2019-06-20 |
Last Update Date | 2024-01-19 |