| NPI | 1275810269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT010541) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P13481) |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2012-02-07 |