| NPI | 1598714867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT 2893) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2014034142) |
| 225100000X Physical Therapist (Licence: GA PT009386) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2014-11-26 |