NPI | 1679931125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1269786) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL pt30707) |
225100000X Physical Therapist (Licence: SC 7940) | |
Enumeration Date | 2016-01-28 |
Last Update Date | 2016-01-28 |