| NPI | 1851016638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 224ZR0403X Occupational Therapy Assistant, Driving and Community Mobility |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2022-10-05 |