| NPI | 1013422617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008490) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P16637) |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical | |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2023-07-21 |