| NPI | 1417445990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 11919R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01716300) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2025-02-27 |