| NPI | 1982043048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011267) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 14243) |
| 225100000X Physical Therapist (Licence: FL PT 28335) | |
| 225100000X Physical Therapist (Licence: NY 010854-1) | |
| 225100000X Physical Therapist (Licence: SC 7061) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2014-09-05 |