| NPI | 1194247320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02020900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029128) |
| 225100000X Physical Therapist (Licence: WA PT60772484) | |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2021-08-04 |