NPI | 1104902998 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251E1300X Physical Therapist Electrophysiology, Clinical (Licence: GA PT000495) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: GA PT000495) |
Enumeration Date | 2006-10-27 |
Last Update Date | 2011-02-28 |