NPI | 1619375276 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1173170) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1173170) |
2251G0304X Physical Therapist, Geriatrics (Licence: TX 1173170) | |
Enumeration Date | 2014-12-15 |
Last Update Date | 2014-12-15 |