| NPI | 1053869842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD CP032273T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01672400) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2024-07-04 |