| NPI | 1427019199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: KY 003233) |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: IN 05007955A) |
| 225100000X Physical Therapist (Licence: IL 070022541) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2025-11-24 |