| NPI | 1003197880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8137) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT010398) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2017-03-23 |