| NPI | 1841580552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009643) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH5940) |
| 225100000X Physical Therapist (Licence: VA 2305206137) | |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-04-14 |