| NPI | 1194146662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT012294) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 40558) |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2016-04-12 |