| NPI | 1588992887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT006441) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT24204) |
| Enumeration Date | 2009-11-24 |
| Last Update Date | 2015-12-11 |