| NPI | 1154381002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8822) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA010116) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2020-03-20 |