| NPI | 1619524394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01872700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 301256) |
| 225100000X Physical Therapist (Licence: MA 26501) | |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2023-02-28 |