| NPI | 1972910131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009237) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT18325) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2014-07-18 |