| NPI | 1902842651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 5720) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT006222) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2007-10-29 |