| NPI | 1457583882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT010903) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031701) |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2013-03-07 |