| NPI | 1669655775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 3511) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT008709) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2017-05-01 |