| NPI | 1346395712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT576) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: ID OT129) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2013-04-19 |