| NPI | 1669645982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: GA PT4336) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT4336) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2008-06-02 |