| NPI | 1548204258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7857) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT007032) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2018-05-24 |