| NPI | 1225493331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1297971) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01634600) |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2024-06-18 |