| NPI | 1376307900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN CP027977T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02191100) |
| Enumeration Date | 2024-02-13 |
| Last Update Date | 2024-02-14 |