| NPI | 1164469565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT6708) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH7978) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2016-05-19 |