| NPI | 1265672414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1172558) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 111414) |
| Enumeration Date | 2009-03-01 |
| Last Update Date | 2014-03-02 |