| NPI | 1528547460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02042400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 295224) |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2021-09-14 |