| NPI | 1336684331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028275) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01712800) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2024-03-18 |