| NPI | 1811536246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: AL PTH9576) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH9576) |
| 225100000X Physical Therapist (Licence: GA PT016267) | |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2024-02-19 |