| NPI | 1235552670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant |
| 225200000X Physical Therapy Assistant | |
| 225500000X Specialist/Technologist | |
| 225700000X Massage Therapist | |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2014-01-21 |
| Last Update Date | 2014-01-21 |