| NPI | 1578822821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MT 824) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2012-05-07 |