| NPI | 1295804649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT18680) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT007714) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2018-12-03 |