| NPI | 1407810765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT22976) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT006199) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2016-10-20 |