| NPI | 1417208315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21074) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P100311E) |
| 225100000X Physical Therapist (Licence: NJ 40QA01463800) | |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2023-08-14 |