| NPI | 1598205692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213709) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01719800) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2020-09-10 |