NPI | 1558056317 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1368121) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT04057) |
Enumeration Date | 2023-04-07 |
Last Update Date | 2025-09-12 |