| NPI | 1093730764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT22244) |
| Additional Taxonomies | 225XH1200X Occupational Therapist Hand (Licence: FL OT10086) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-07-08 |