| NPI | 1215155940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013273) |
| Additional Taxonomies | 171W00000X Contractor (Licence: FL LPTA19978) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2018-06-19 |