| NPI | 1467616458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012290) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT14933) |
| 225100000X Physical Therapist (Licence: NC P11802) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2020-11-29 |