| NPI | 1114316031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01800800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003262) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2023-11-30 |