| NPI | 1144243817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT007300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 7300) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2013-09-04 |