| NPI | 1306962170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT008718) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: GA OT004504) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2009-01-20 |