| NPI | 1194094276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01481500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1210060) |
| 225100000X Physical Therapist (Licence: TN 8990) | |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2020-03-03 |