| NPI | 1205172673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1292298) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01474500) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2020-01-08 |