| NPI | 1174573950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT006616) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH1858) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-01-27 |