| NPI | 1730342981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15997) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009359) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2015-12-07 |