| NPI | 1396280814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01848600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292534) |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2022-10-31 |