| NPI | 1750388922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT005992) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT17063) |
| Enumeration Date | 2005-07-04 |
| Last Update Date | 2007-07-08 |