| NPI | 1245330174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: TX 1040822) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1040822) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2007-10-11 |