NPI | 1811451313 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: TX 1329784) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 30478) |
225100000X Physical Therapist (Licence: MD 27152) | |
Enumeration Date | 2019-01-29 |
Last Update Date | 2021-09-14 |