| NPI | 1134113665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT19787) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT007271) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2007-07-08 |