| NPI | 1346320611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207829) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017710) |
| 225100000X Physical Therapist (Licence: NJ 40QA01197300) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2024-03-15 |