| NPI | 1063880912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT17016) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT30324) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-09 |