| NPI | 1619175395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: GA 009090) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: GA PT009090) |
| 2251S0007X Physical Therapist, Sports (Licence: GA PT009090) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2014-05-29 |