| NPI | 1184749665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1151019) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018053) |
| 2251X0800X Physical Therapist Orthopedic (Licence: PA PT018053) | |
| 225100000X Physical Therapist (Licence: NJ 40QA01239900) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-01-15 |