NPI | 1720761430 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 11932R) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1379577) |
Enumeration Date | 2023-08-09 |
Last Update Date | 2024-09-10 |