| NPI | 1811930506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251H1200X Physical Therapist, Hand (Licence: GA PT000649) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT000649) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2011-11-02 |