| NPI | 1679774806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT007169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT23048) |
| Enumeration Date | 2007-05-28 |
| Last Update Date | 2007-07-08 |