| NPI | 1063813095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01903400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003161) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2022-03-11 |