| NPI | 1174573844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: AL PTH1859) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH1859) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AL PTH1859) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2024-08-28 |