| NPI | 1265990683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 302327) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01849100) |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2024-02-15 |