| NPI | 1497123251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012560) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 30590) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2018-02-14 |