| NPI | 1407168941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT013638) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 6236) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2018-09-10 |