| NPI | 1477803310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012388) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 26471) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2016-06-22 |