| NPI | 1417516907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: FL PT34297) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT34297) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2025-03-12 |