| NPI | 1083967830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT010705) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9348) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2019-03-14 |