| NPI | 1851627079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009812) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT009812) |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2016-12-19 |