| NPI | 1417669698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7916) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: AL OT4080) |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2022-12-19 |