| NPI | 1891239042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01707400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP033593T) |
| 225100000X Physical Therapist (Licence: CO CP024954T) | |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2024-10-11 |