| NPI | 1316271679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011452) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2009028456) |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2015-07-21 |