| NPI | 1730671777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC 870888) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: DC OT130) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2018-06-05 |