| NPI | 1093938722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT002327) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: GA OT000620) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-09 |