| NPI | 1366895187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL 17090) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 17090) |
| Enumeration Date | 2016-07-16 |
| Last Update Date | 2016-07-16 |