| NPI | 1194144105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 10088) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL 15590) |
| 225X00000X Occupational Therapist (Licence: TN 4979) | |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2014-05-29 |