| NPI | 1891739702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT21456) |
| Additional Taxonomies | 225XH1200X Occupational Therapist, Hand (Licence: FL OT11336) |
| 225X00000X Occupational Therapist (Licence: FL OT11336) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-10-17 |