NPI | 1386095610 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT-2024-0171) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WY 750) |
Enumeration Date | 2016-06-28 |
Last Update Date | 2024-06-25 |