| NPI | 1972884120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2011-09-01 |