| NPI | 1972844611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: MD 27713) |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: NY 036121) |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2025-05-15 |