| NPI | 1790968154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ CP031482T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305005465) |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2024-10-31 |