| NPI | 1689776379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT007856) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: GA PT007856) |
| 2251P0200X Physical Therapist Pediatrics (Licence: GA PT007856) | |
| 2251S0007X Physical Therapist Sports (Licence: GA PT007856) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2016-05-24 |