| NPI | 1720504327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01804500) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: ME PT5001) | |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2021-04-09 |