| NPI | 1861821472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: MD 12940) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT002986E) |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: PA PT002986E) | |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2018-06-26 |