| NPI | 1346690013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01672700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305210372) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2021-10-05 |