NPI | 1508392101 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 09616) |
Additional Taxonomies | 225100000X Physical Therapist |
225100000X Physical Therapist (Licence: TX 1356367) | |
Enumeration Date | 2017-05-03 |
Last Update Date | 2023-04-11 |