| NPI | 1437240058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011350) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT 002934) |
| 225100000X Physical Therapist (Licence: CA PT 22176) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2014-04-05 |