| NPI | 1356696769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT010655) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH6572) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2012-10-04 |