| NPI | 1720338999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011259) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27639) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2013-10-08 |