| NPI | 1235234972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030388) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01149200) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2022-11-29 |