NPI | 1710618889 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1352811) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1352811) |
Enumeration Date | 2022-06-20 |
Last Update Date | 2023-06-29 |