| NPI | 1033605308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10045) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: SC 6117) |
| 225X00000X Occupational Therapist (Licence: FL OT18299) | |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2024-03-25 |