| NPI | 1558774935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: MD 21375) |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: PA PT008376L) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2014-06-03 |