| NPI | 1043382013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 7000660) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NJ 40QA0826300) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2024-01-03 |