| NPI | 1518307859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT24647) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009552) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2015-02-04 |