| NPI | 1730486671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 10861) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01386100) |
| 225100000X Physical Therapist (Licence: TN 10373) | |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2023-03-01 |