| NPI | 1104891217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT19154) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: FL exempt) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2013-05-20 |