| NPI | 1124256524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 4045260) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2026-08-18 |