NPI | 1790200939 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019263) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11546) |
225100000X Physical Therapist (Licence: TX 1318973) | |
Enumeration Date | 2017-08-09 |
Last Update Date | 2024-10-07 |