| NPI | 1548571961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1181643) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: TX 1181643) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2024-08-22 |