| NPI | 1477864312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7643) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009950) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2015-01-16 |