| NPI | 1003286972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1309289) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 213531) |
| Enumeration Date | 2015-10-04 |
| Last Update Date | 2025-01-10 |