| NPI | 1316975006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT003704) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305202361) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2007-10-22 |