| NPI | 1578141305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12285) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030938) |
| 225100000X Physical Therapist (Licence: VA CP029506T) | |
| 225100000X Physical Therapist (Licence: NJ 40QA02001500) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2024-05-16 |