| NPI | 1275831778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003839) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033145) |
| 225100000X Physical Therapist (Licence: NJ 40QA01436200) | |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2018-04-30 |