| NPI | 1386855278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: FL MA 44756) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9667060) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2024-08-19 |