| NPI | 1598193583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14946) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40qa01477300) |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2023-11-29 |