| NPI | 1477603744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5807) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT 12524) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2008-11-10 |