| NPI | 1861655185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT9607) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: TN 8093) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2012-02-23 |