| NPI | 1568754794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: GA pt009750) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA pt009750) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2020-03-20 |