| NPI | 1679822183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT30157) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT010798) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2015-11-16 |