| NPI | 1629536776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: GA PT014745) |
| 261QP2000X Clinic/Center Physical Therapy | |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2023-08-24 |