| NPI | 1235228362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P2899) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011958) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2018-03-17 |