| NPI | 1144675000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0004022) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01659200) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2019-02-11 |