| NPI | 1952664559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 18721) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: TX MT007325) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2012-06-19 |