| NPI | 1275958670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT0000009828) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009120) |
| Enumeration Date | 2014-02-22 |
| Last Update Date | 2014-02-22 |