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 |