| NPI | 1679397608 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1335096) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1335096) |
| Enumeration Date | 2024-11-15 |
| Last Update Date | 2024-12-17 |