| NPI | 1992080121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT010445) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: GA 010445) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2014-03-19 |