| NPI | 1801214077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT28997) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011403) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2014-04-03 |