| NPI | 1578142964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01999600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018879) |
| 225100000X Physical Therapist (Licence: PA PT029387) | |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2021-04-05 |