| NPI | 1013311224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011710) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH10789) |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: AL PTH10789) | |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2024-09-03 |