| NPI | 1164736716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT002626) |
| Additional Taxonomies | 2251C2600X (Licence: GA PT002626) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2010-08-05 |