| NPI | 1174566293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251H1200X Physical Therapist, Hand (Licence: OR 1033456) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC006465L) |
| 225X00000X Occupational Therapist (Licence: OR 1033456) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-12-19 |