NPI | 1770144560 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT26105) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA26276) |
Enumeration Date | 2019-06-24 |
Last Update Date | 2025-05-23 |