| NPI | 1447579990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1235169) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 117809) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2016-10-25 |