| NPI | 1023087541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: GA 3166) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT003166) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2025-05-01 |