| NPI | 1427228667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012048) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017858) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2017-02-01 |