| NPI | 1043603814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1356635) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 26939) |
| 235Z00000X Speech-Language Pathologist, (Licence: CA 19350) | |
| 235Z00000X Speech-Language Pathologist, (Licence: TX 119077) | |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2023-08-24 |