NPI | 1760563605 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1108207) |
Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: TX 1108207) |
Enumeration Date | 2006-10-18 |
Last Update Date | 2024-06-12 |