| NPI | 1174521868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT008470) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 15262) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2015-11-10 |