NPI | 1922562073 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1240177) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: TX 12040177) |
Enumeration Date | 2019-01-23 |
Last Update Date | 2019-01-23 |