| NPI | 1326076514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8140) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00912700) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2022-01-16 |