| NPI | 1316379308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15717) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011099) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2017-02-28 |