| NPI | 1992935936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL FL3254) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL0995) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2009-07-24 |