| NPI | 1013382464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29813) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT15879) |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2015-12-10 |