| NPI | 1053657288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT20482) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT007594) |
| Enumeration Date | 2012-12-16 |
| Last Update Date | 2012-12-16 |