NPI | 1518574789 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist |
Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX 1309236) |
Enumeration Date | 2020-09-30 |
Last Update Date | 2020-10-14 |