| NPI | 1255490892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1112829) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2018-03-16 |