| NPI | 1710282041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1123313) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 111483) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2015-09-29 |