| NPI | 1083982565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 4300-24) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WI 1811-26) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2011-12-12 |