| NPI | 1134382146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: GA PT009320) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009320) |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: AL PTH6102) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2022-07-21 |