NPI | 1992186936 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: TX 1251657) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1251657) |
Enumeration Date | 2015-06-16 |
Last Update Date | 2015-06-16 |