| NPI | 1649734666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01906100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0004026) |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2020-05-11 |