| NPI | 1811365935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024695) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: PA F03946) |
| 225200000X Physical Therapy Assistant (Licence: NJ 40QA01647300) | |
| Enumeration Date | 2015-09-05 |
| Last Update Date | 2024-11-05 |