| NPI | 1184236259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: GA 014907) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 014907) |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: PA PT033235) | |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2026-06-04 |