| NPI | 1144499146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: GA PT008390) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT008390) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT008390) | |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2020-03-31 |