| NPI | 1215078639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Q00000X Developmental Therapist (Licence: FL PT22553) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT22553) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2014-09-11 |