| NPI | 1932178589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 10009) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT003109) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-07-08 |