| NPI | 1194254268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01621200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT292226) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2017-06-12 |