| NPI | 1174858310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT007968) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT007968) |
| 225100000X Physical Therapist (Licence: SC PT.9934) | |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2019-10-29 |