| NPI | 1790806073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009856) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 9154) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2016-03-23 |