| NPI | 1407949134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT004832) |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: GA PT004832) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2010-11-10 |