| NPI | 1649233941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT008288) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT22694) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2016-08-16 |