| NPI | 1477939841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 078882) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01499700) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2019-10-18 |