NPI | 1811393622 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2021040977) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT29602) |
225100000X Physical Therapist (Licence: TX 1259742) | |
Enumeration Date | 2014-11-06 |
Last Update Date | 2025-03-18 |