| NPI | 1255700332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8869) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 082089) |
| 225100000X Physical Therapist (Licence: NJ 40QA01620200) | |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2018-12-17 |