| NPI | 1114112224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 10434-24) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WI 3716-26) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2022-10-12 |