| NPI | 1487306908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 124546) |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2026-02-04 |