| NPI | 1811451313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: TX 1329784) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 30478) |
| 225100000X Physical Therapist (Licence: MD 27152) | |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2021-09-14 |