| NPI | 1013307578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292002) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01529800) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2021-09-23 |