| NPI | 1578742771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 41400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00905600) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2024-10-01 |