| NPI | 1124079991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT007364) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 7364) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2010-12-17 |