| NPI | 1265785661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: KY 006085) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006085) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2019-01-09 |