| NPI | 1801974035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 005434) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic |
| 261QP2000X Clinic/Center Physical Therapy | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2023-08-30 |