| NPI | 1306176136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT24976) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009660) |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2018-03-16 |