| NPI | 1427124908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6444) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: GA pt009213) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2023-05-09 |