| NPI | 1043697634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01556700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037554) |
| 225100000X Physical Therapist (Licence: MI 5501016943) | |
| Enumeration Date | 2015-05-03 |
| Last Update Date | 2015-05-03 |