| NPI | 1962409144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT21231) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT007061) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2007-10-22 |