| NPI | 1801313473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20047) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11813) |
| 225100000X Physical Therapist (Licence: NJ 40QA01970000) | |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2025-08-21 |