| NPI | 1932577921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8128) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 09031R) |
| 225X00000X Occupational Therapist (Licence: LA OTT.200871) | |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2022-07-21 |