Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | A025405 | CA |
NPI | 1265599708 |
---|---|
Provider Name | Mr. Gregory Bogdan Kirkorowicz |
First Address | Irvine, CA 92618 |
Second Address | Santa Ana, CA 92705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |