| NPI | 1609310317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01992700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037966-1) |
| 225100000X Physical Therapist (Licence: HI PT-4278) | |
| 225100000X Physical Therapist (Licence: NC P15747) | |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2021-02-17 |