| NPI | 1871650143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT003546) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT22176) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2019-05-30 |