| NPI | 1447380027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8018) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT008243) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2014-08-18 |