| NPI | 1285952903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009809) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH2241) |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2010-05-05 |