| NPI | 1740237395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 11388) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT007931) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2011-05-04 |