| NPI | 1629085980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5178) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT 007458) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-03-28 |