| NPI | 1316232804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT15238) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT26262) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2024-06-28 |