| NPI | 1861466484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: AK 109306) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 5063) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2018-09-18 |