| NPI | 1538660576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030959) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01777700) |
| 225100000X Physical Therapist (Licence: MD CP039217T) | |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2025-07-01 |