| NPI | 1467491506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01098600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002548) |
| 225100000X Physical Therapist (Licence: PA PT024895) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2016-11-18 |