| NPI | 1447579990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1235169) |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: TX 1235169) |
| 225X00000X Occupational Therapist (Licence: TX 117809) | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2025-11-21 |