| NPI | 1063407427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT007820) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 3622) |
| 225100000X Physical Therapist (Licence: NC 6732) | |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2020-05-12 |