| NPI | 1629293832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4009) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01233400) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2021-04-19 |