| NPI | 1942556311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MS 2664) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: MS 5208) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| 225100000X Physical Therapist (Licence: MS 5208) | |
| 225700000X Massage Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: MS 2664) | |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2022-02-23 |