| NPI | 1033265319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT011222) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NE 2226) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2015-09-28 |