| NPI | 1851786784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0016830) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01604200) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2020-10-06 |