| NPI | 1033546536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: NV 225XP0019X) |
| Enumeration Date | 2013-09-30 |
| Last Update Date | 2023-07-20 |