| NPI | 1376603092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1343) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: SD 1137) |
| 235Z00000X Speech-Language Pathologist, (Licence: SD 1351) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2025-10-10 |