| NPI | 1316140411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA OT4083) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: AZ 1875) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2012-04-20 |