| NPI | 1558442087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009829) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008605A) |
| 225100000X Physical Therapist (Licence: KY 004774) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2009-11-13 |