NPI | 1700125861 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: UT 116341-2401) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: UT 116341-2401) |
Enumeration Date | 2013-02-10 |
Last Update Date | 2013-02-10 |