| NPI | 1013307768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: KY 008998) |
| 225100000X Physical Therapist (Licence: KY 008998) | |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: WY 1564) | |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2024-01-03 |