| NPI | 1912051632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 1735) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NV 0662) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |