| NPI | 1679707491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ NJ40QA01415600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT3252) |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2024-10-17 |