| NPI | 1043687197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013481) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305211586) |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2019-01-29 |