| NPI | 1255495180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 5683) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA04764) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2023-07-25 |