| NPI | 1669812632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009915) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1222729) |
| Enumeration Date | 2013-07-04 |
| Last Update Date | 2013-07-04 |