| NPI | 1386838852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009340) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5522) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2008-08-29 |