| NPI | 1548245236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-1920) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 1920) |
| 225X00000X Occupational Therapist (Licence: ID 711) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ID AT-142) | |
| 225X00000X Occupational Therapist (Licence: ID OT-711) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2010-10-01 |