| NPI | 1528066057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT007132) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT23358) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2007-10-22 |