| NPI | 1548364706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT008550) |
| Additional Taxonomies | 171W00000X Contractor (Licence: GA 8550) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2011-10-04 |