| NPI | 1457553679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT23393) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT12706) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2007-07-08 |