| NPI | 1740266055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT010926) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1136638) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2019-04-03 |