| NPI | 1861548281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: GA PT 005228) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT005228) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2016-03-01 |