| NPI | 1487198735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1403427) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01696300) |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2025-07-21 |