| NPI | 1578693131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6295) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10205) |
| 225100000X Physical Therapist (Licence: NJ 40QA01172100) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2015-02-27 |