| 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 |