| NPI | 1902130024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT008467) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 009835) |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2009-11-20 |