| NPI | 1154760767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7430) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PTO10986) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2015-01-21 |