| NPI | 1093746638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009114) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL pt17884) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2016-03-18 |