| NPI | 1649599341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23559) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009014) |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2016-03-08 |