| NPI | 1558439257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XH1200X Occupational Therapist, Hand (Licence: WA OT60257391) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT22183) |
| 225X00000X Occupational Therapist (Licence: FL OT11990) | |
| 225100000X Physical Therapist (Licence: WA PT00010876) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2015-09-30 |