| NPI | 1205202496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012042) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7773) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2015-08-11 |