NPI | 1588150270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1309347) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1309347) |
225100000X Physical Therapist (Licence: SC 9640) | |
Enumeration Date | 2018-07-05 |
Last Update Date | 2022-12-30 |