NPI | 1982203840 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1384870) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 11746R) |
225100000X Physical Therapist (Licence: FL PT36227) | |
Enumeration Date | 2020-10-21 |
Last Update Date | 2025-06-18 |