| NPI | 1831164045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT005245) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT005245) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2007-07-08 |