| NPI | 1558147801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1280149) |
| Additional Taxonomies | 171WH0202X Contractor Home Modifications |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2023-09-04 |