| NPI | 1255738209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 302006) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01582100) |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2022-10-12 |