| NPI | 1063452589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT008252) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH4454) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2019-01-07 |