| NPI | 1710012430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT2182) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: ID PT-815) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-11-13 |