| NPI | 1710392972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21865) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01550600) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2023-10-17 |