| NPI | 1710499041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP042247T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01736900) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2026-03-16 |