| NPI | 1851321640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012668) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1108025) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2016-10-12 |