| NPI | 1376997353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 293431) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01657000) |
| Enumeration Date | 2016-04-16 |
| Last Update Date | 2019-05-17 |