| NPI | 1457629784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX PT1201149) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX OT113851) |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2011-12-01 |