| NPI | 1326456435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011944) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023893) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2015-08-11 |