| NPI | 1255000154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016395) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02043200) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2023-02-28 |