| NPI | 1013187095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 24086) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL 12648) |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2008-07-08 |