| NPI | 1992044101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 8022) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT010919) |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2016-01-21 |