| NPI | 1508935784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7816) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01394400) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2021-05-15 |