| NPI | 1578955076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18511) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 18511) |
| 225100000X Physical Therapist (Licence: NJ 40QA01597400) | |
| Enumeration Date | 2015-02-21 |
| Last Update Date | 2024-01-23 |