NPI | 1144850629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02165900) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0016759) |
225100000X Physical Therapist (Licence: MA PTL0016759) | |
Enumeration Date | 2020-01-23 |
Last Update Date | 2023-06-01 |