| NPI | 1548456684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT 12890) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 23875) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2008-07-10 |