| NPI | 1114413879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29366) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT026976) |
| 225100000X Physical Therapist (Licence: NJ 40QA01797500) | |
| 2251X0800X Physical Therapist Orthopedic | |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2024-02-28 |