| NPI | 1386838977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT 008632) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: GA OT 004306) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2008-03-14 |