| NPI | 1609899970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10943) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 10943) |
| 225100000X Physical Therapist (Licence: NJ 40QA01100900) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-03-13 |