| NPI | 1245577485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT010910) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9488) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2014-03-05 |