| NPI | 1447329263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT004124) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 25720) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2018-03-06 |