| NPI | 1275926750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01994700) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: PA PT028306) | |
| 225100000X Physical Therapist (Licence: VA 2305211119) | |
| 225100000X Physical Therapist (Licence: NY 038709) | |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2021-03-09 |