| NPI | 1760091532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| 225800000X Recreation Therapist | |
| 227800000X Respiratory Therapist, Certified | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2020-07-28 |